PSA spike 6 months after stopping AVODART abruptly

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montreal123
New Member


Date Joined Oct 2013
Total Posts : 9
   Posted 10/11/2013 11:11 AM (GMT -6)   
Hello,

This is my first post.

In 2008, at age 59, my PSA, which had been under 3 for decades, suddenly spiked to 6.19 during a 10 month period.

During the following year, my PSA oscillated up and down hitting a low at 3.55 and a new high at 6.71, which triggered my urologist's demand for a biopsy (turned out to be negative).

During the year following my negative biopsy, my PSA fell to 4.69, but later hit a new record of 8.68.

My urologist then put me on AVODART and within 3 months I was down to 2.7 (January 2011) and the majority of my PSA scores stayed below 3 except for one exception at 5.14 .

In March 2013, after I reported recent increased swelling in my breasts, my urologists took me off AVODART abruptly, claiming that the benefit of taking AVODART did not justify having my side effect.

This week, being 6 months after stopping AVODART, my latest PSA came in at 13.65 (5 days of abstinence) and 2 days later a second test came in at 14.23 , a slight gain over 2 days due to resumed sexual activity.

I should add that I had a urinary track infection 3 weeks earlier (fever of 102 F.) which was treated with a 10 days of CIPRO. CIPRO, like some antibiotics normally
reduces PSA slightly, but I wonder if the original UTI may have caused some trauma to my prostate, contributing to a rise in PSA measured 3 weeks later.

As I understand, AVODART reduces the way testosterone acts on the prostate, but how does the prostate react when it begins to get a full load of testosterone due to cessation of AVODART? Does the prostate over react by enlarging to an even larger size than it was prior to starting AVODART?

I cannot say that in the time since stopping AVODART, my frequency or difficulty in urination is any worse than prior to starting AVODART.

Any comments would be appreciated from anyone who has actually stopped AVODART after taking it for several years.

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10108
   Posted 10/11/2013 1:33 PM (GMT -6)   
The up-and-down pattern in your PSA is characteristic of prostatitis or a urinary tract blockage, rather than BPH or Cipro. Prostatitis relapses and remits. It is often not responsive to antibiotics, especially if you've had them before and have become resistant. You might have BPH as well, which would account for the reduction in PSA when you took Avodart - has your Uro measured your prostate size? Did your biopsy mention inflammation and/or hyperplasia?

montreal123
New Member


Date Joined Oct 2013
Total Posts : 9
   Posted 10/11/2013 2:29 PM (GMT -6)   
Thanks Tall Allen for your response. Very encouraging.

I do have BPH. But I don't recall what else the negative biopsy detected.

I've had non-infectious prostatitis since age 33. I was often the youngest patient in my urologist's waiting room filled exclusively with older men (as I am now). Through my 30's, 40's and most of my 50's, my annual PSA was always under 3 with a variance of 1.5 points off the average.

Then, in the fall of 2008, I may have strained my prostate acquiescing to the excessive desires of a new girlfriend and since then I've had this roller-coaster ride of ups and downs in PSA, until AVODART seemed to calm everything down in 2010.

In early 2009, I had the controversial genetic PCA3 test which does not detect the presence of any pathology, but rather issues a score as to the probability of the presence of cancerous cells. The PCA3 test is independent of all the environmental factors that distort a regular PSA test, like riding a bicycle, recent sexual activity, low grade UTIs, diet, and latent inflamation. It is so experimental a test that my insurance refused to pay the $375 cost.

My PCA3 test had a score of 42 on a scale that suggested that (pre-) cancer might be present in 2 cases out of 3. Those odds seemed discouraging until my followup 10 needle biopsy came back negative. I realize that of all the people with a PCA3 score of 42, 1 in 3 would have a false positive, but I always wondered if my biopsy missed something.

In the few hours since I created the initial post in this thread, I found a caveat on the internet claiming that a PSA test done without waiting more than 6 months after a UTI may not be useful.

So it's a bit comforting knowing that the UTI (in which I had a high fever and suffered chills) which I had 3 weeks prior to my recent PSA test may have contributed to the PSA spike, but by how much?

But more importantly, I wonder how the prostate reacts to receiving a marked increase in testosterone for the first time in nearly 3 years and how the other glands in my body which normally have a cooperative hormonal equilibrium amongst themselves may have inter-reacted, perhaps in an exaggerated way.

So far I've read on the internet only one person claiming that their PSA tripled after coming off AVODART, going from 2 to 6, compared to my going from 2 to 14.

Thanks again for your comment.

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10108
   Posted 10/11/2013 4:34 PM (GMT -6)   
I think your history of BPH and prostatitis may explain it all. When you got off the Avodart, your BPH reared its ugly head again, increasing your PSA. That, along with your non-infectious prostatitis will always make the use of PSA to look for PC problematic for you. PCA3 is only a clue, as you say. Did you also have a free PSA test? Hopefully soon the new PHI test will become available in North America. There are other biomolecular markers (e.g., TMPRSS:ERG fusion, AMACR, etc) that are in clinical trials that you might qualify for.

Your other option is to have repeat biopsies, perhaps using one of the advanced imaging techniques (e.g, mpMRI or color doppler ultrasound) or a saturation biopsy.

Actually, Avodart increases your T level. T is metabolized by an enzyme called 5-alpha-reductase (5ar) into dihydrotestosterone (DHT). DHT is much more powerful than T at aggravating BPH. Avodart inhibits the 5ar enzyme. When the T can no longer get metabolized into BPH, your body will metabolize the excess T into estrogen using an enzyme called aromatase. The increase in estrogen is what caused your breast swelling (gynecomastia). Testosterone abusers take aromatase inhibitors (e.g., Aromasin) or estrogen blockers (e.g., Tamoxifen) to prevent that.

The arguments in favor of continuing on Avodart are:
• there is a lot of very good evidence that Avodart prevents low grade PC
• it keeps your PSA more stable, enabling you to detect changes that are not related to BPH.
• the gynecomastia can be prevented with 10 mg tamoxifen/day
• it prevents balding and thickens hair

The argument against it is:
• in up to 20% of men, it may dampen sex drive.

- Allen

montreal123
New Member


Date Joined Oct 2013
Total Posts : 9
   Posted 10/11/2013 5:50 PM (GMT -6)   
Thanks Allen for your detailed response.

The message I'm getting from responses to this thread thus far is that given my long term history and recent UTI, I should not be panicking at seeing my PSA jump from 2.14 with AVODART to 13.65 without AVODART over a 6 month period.

My gynecomastia acquired in my second year on AVODART is just enough to make me feel awkward in the gym locker room or on the beach, but not enough to be willing to risk getting PC by staying off AVODART.

I read that once you get gynecomastia as a side effect, it doesn't disappear when one stops AVODART, the way other side-effects like ED disappear.

So I'll probably need cosmetic surgery liposuction to get rid of the excess breast tissue.

And the tamoxifen which you suggest with AVODART may decrease the chance of new breast tissue developing. As for the hair, I've been bald since age 35 and I've kind of gotten used to it.

AVODART didn't reduce my sex drive in any way during my two and a half years on AVODART, so I hope that by adding tamoxifen, my sex drive will stay the same as it was with AVODART alone.

Thanks again....

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10108
   Posted 10/11/2013 6:20 PM (GMT -6)   
I wouldn't panic over the increased PSA, but I wouldn't ignore it either. I'm not a doctor, and you should seek a doctor's advice about all this.

Gynecomastia is also a problem for many men taking bicalutamide for advanced prostate cancer. In one study, researchers found that tamoxifen 10 mg/day could prevent "breast events," but tamoxifen at 20 mg/day could reverse them if they have not gone on too long:

A randomized trial comparing tamoxifen therapy vs. tamoxifen prophylaxis in bicalutamide-induced gynecomastia.

After a while, fibrosis of breast tissue sets in that tamoxifen can't reverse. Then, corticosteroid injections can break down the excess tissue or surgery can remove it.

- Allen

montreal123
New Member


Date Joined Oct 2013
Total Posts : 9
   Posted 10/11/2013 7:16 PM (GMT -6)   
Thanks again Allen for all your help, it sure took a load off of me today.

In 10 days I will be seeing my urologist and in 17 days, my endocrinologist, so I will have all these experts to propose solutions to getting my hormones back in shape.

I'll post their comments in this thread in the hope it might someday help another person who could be ill prepared for the consequences of stopping AVODART.

Bye for now....

Break60
Veteran Member


Date Joined Jun 2013
Total Posts : 1848
   Posted 10/16/2013 12:46 PM (GMT -6)   
I'm not a doctor. But Avodart does reduce your PSA by about half. So stopping it would make it double. I was not aware of this.
 
I took Avodart for ten years BPH to shrink my prostate. Then I switched to finasteride which is generic proscar.  It worked and my BPH became more tolerable.
 
Then my PSA started to climb from .4 to 2.16 to 5.4 to 6.6 over the last three years so I had a biopsy. Gleason 9 PC was found in two of six cores. I read up on finasteride and found that it reduced PC incidence by about 25%, but increased high risk PC.
 
That's exactly what happened to me. So if you find your PSA increasing, get a biopsy ASAP!
 
Bob

Nomar Lupron 4 Me
Veteran Member


Date Joined Apr 2013
Total Posts : 1922
   Posted 10/16/2013 7:03 PM (GMT -6)   
Check out Dr Charles "Snuffy" Myers weekly videos that are free after you enroll using this link:

http://www.prostateforum.com/

Then if you page back far enough, you can find virtually every PCa topic imaginable has been discussed

https://askdrmyers.wordpress.com/

In a recent article Dr Myers goes into all the side effects and the work arounds for them including the moobs, man boobs.

JerryL also started a HW thread today on the Dr Myers Avodart video.

http://www.healingwell.com/community/default.aspx?f=35&m=2880894

LupronJim

LupronJim
65 - DX 64 Feb 2013 PSA 3.68 (6 mo doubling) Gleason 9 (4+5)

T1CN0M1B stage IV w. 7 of 12 cores worst ones 70% right perineural Invasion PNI

oligometastatic 5 tumors 1 right sacroiliac, 2 thoracic vertebral bodies (spine), 2 right posterior ribs

1st Lupron 4 month 3-28-2013, 2nd Aug 1
PSA 3.68 down on 07-08-13 @ 0.2, T=24

UF & Shands treating w curative intent, not just palliative.

LupronJim

montreal123
New Member


Date Joined Oct 2013
Total Posts : 9
   Posted 10/17/2013 3:30 PM (GMT -6)   
Thanks LupronJim and Break60 for your added information.

I will see my doctor in 2 days so before I draw any conclusions or go searching for any more answers, I'm going to talk to him first.

montreal123
New Member


Date Joined Oct 2013
Total Posts : 9
   Posted 10/23/2013 11:20 AM (GMT -6)   
Unfortunately my doctor's appointment was cancelled and rescheduled for a week later. I'll post his advice next week......

montreal123
New Member


Date Joined Oct 2013
Total Posts : 9
   Posted 10/30/2013 10:59 AM (GMT -6)   
I saw my endocrinologist yesterday and my urologist this morning.

The urologist said that a UTI can cause one's PSA to spike to over 100 and that any PSA test should never be done within 6 weeks of a UTI. I read elsewhere that it can take up to 6 months for PSA to settle down following a UTI.

When I had my PSA done recently, it was only 3 weeks following my UTI (11 days following the end of my 10 days of antibiotics).

The urologist wants to repeat the PSA in 3 months before deciding the next step.

The endocrinologist also wants to do a test for T in 3 months and should the decision be made by the urologist to put me back on Avodart, the endocrinologist said he was prepared to offer me an aromatase inhibitor in order to reduce the chances of having my previous bout of gynecomastia restarting.

When I asked my urologist if a reduced dose of Avadart might stabilize my PSA without breast side effects, he said that there is no proof that a partial dose of Avadart provides proportional protection compared to a full dose. I asked how the same dose can be as compatible with a 145 pound man as it might be for a 220 pound man. He had no answer.

I'll post again in January.

montreal123
New Member


Date Joined Oct 2013
Total Posts : 9
   Posted 4/10/2014 1:02 PM (GMT -6)   
In January 2014, my PSA dropped slightly to 11.29 down from 13.65 in October 2013 . Last week (April 2014) it settled down further to 6.34. My urologist had told me last January that if my PSA stayed at 11 or rose slightly, then he would want to do a second biopsy (following the first one in 2008). He said that when the body comes off Avodart, it has no memory of what the PSA was before Avodart was previously started, so the body does not reset the PSA to a value that the body would have produced had I never started Avodart. In other words, if I was at 8.68 before starting Avodart and Avodart brought me down to 3 over a period of 2 years, then after stopping Avodart, the body is not going to set the new PSA back to 8.68 or higher.

My body has appeared to have forgotten about my spike last fall and has now settled down to roughly two times the PSA produced while under Avodart, which is what would have been expected had I not got that UTI last September.

As for my mild gynecomastia, I can't tell if it's going away on its own or not. My endocrinologist said to give it a year or more to see what happens before considering other options like surgery.

PeterDisAbelard.
Forum Moderator


Date Joined Jul 2012
Total Posts : 5865
   Posted 4/10/2014 1:31 PM (GMT -6)   
Things seem to be going in the right direction just now. Try to be happy about that but continue to keep an eye on things.
60
Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012:
1)neg (some inflammation),
2)neg,
3)positive 1 of 14 GS6(3+3) 3-4%, 2nd opinion GS7(3+4)
4)neg.
Mild Pre-op ED
DaVinci RRP 6/14/12. left nerve spared
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
Start 24 mo ADT3 7/26/12
Adjuvant IMRT 66.6 Gy 10/17/12 - 12/13/12
Leaky but better, Trimix, VED
Forum Moderator - Not a Medical Professional

montreal123
New Member


Date Joined Oct 2013
Total Posts : 9
   Posted 4/10/2014 1:59 PM (GMT -6)   
Thanks PeterDisAbelard for your good wishes.

I'm sure that my recent PSA score will be temporary. I just hope that there will be some stability over time, enough to establish a reference point for future changes.

What is clear from my last 6 month experience is the degree that a UTI can falsify any PSA reading for several months and how Avodart predictably cuts a PSA score in half to the extent that after stopping Avodart, it is reasonable to expect a doubling of the PSA, but not a quadrupling.
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